完全型纵隔内甲状腺癌罕见,我们收治一例,报告如下。病例介绍患者男性,66岁。一个月前无明显原因出现左胸部阵发性钝痛,向肩背部放射。胸透发现左肺上叶阴影,诊断为“肺结核”而行抗痨治疗1个月,症状未见减轻,怀疑“肺癌”于1991年1月26日入院治疗。查体:神志清晰,精神好,消瘦。皮肤粘膜无异常,全身浅表淋巴结未触及。头颅无畸形,眼球无外凸。甲状腺不肿大,无结节。左上肺呼吸音略低,心、腹无异常。胸片示:气管右移,左侧第一、二肋间见一5cm×5cm阴影,边缘光滑,密度均匀。CT检查:纵隔右移,左肺尖至主动脉弓水平有5cm×8cm肿块,CT值33±16Hu,边缘光整。纤维支气管镜检查未见异常。1991年2月8日全麻下开胸:肿瘤位于前上纵隔,与肺尖粘连,8cm×6cm大小,质韧实,包膜完整,表面血运丰富,与锁骨下动脉粘连紧密,完整摘除。标本呈椭圆形,表面有多个小分叶,中央有坏死区,周边多个分隔。病理诊断为纵隔异位甲状腺滤泡型腺癌。术后行甲状腺B超及~(131)I检查未见异常。 Complete thyroid cancer in the mediastinum is rare. We treat one case and report it as follows. Case presentation Male patient, 66 years old. One month ago, there was no apparent cause of paroxysmal dull pain in the left chest and radiation to the shoulders. The thorax revealed a shadow of the left upper lobe and was diagnosed as “tuberculosis.” After 1 month of anti-tuberculosis treatment, the symptoms did not decrease. Suspected “lung cancer” was admitted to hospital on January 26, 1991. Physical examination: Consciousness, good spirits, weight loss. There was no abnormality in the skin and mucous membranes, and no superficial lymph nodes were touched. The skull is not deformed and the eyeball is not convex. The thyroid gland is not swollen and there are no nodules. The upper left lung had a slightly lower breath sound and no abnormalities in heart and abdomen. The chest radiograph showed that the trachea shifted to the right, and a 5cm×5cm shadow was seen between the first and second intercostal spaces on the left side, with smooth edges and uniform density. CT examination: Right mediastinal shift, the left lung tip to the aortic arch level 5cm × 8cm mass, CT value 33 ± 16Hu, edge finishing. No abnormalities were seen with fiberoptic bronchoscopy. On February 8, 1991, the thorax was opened under general anesthesia: the tumor was located in the anterior superior mediastinum and adhered to the apex of the lungs. It was 8 cm x 6 cm in size, quality and toughness, and the capsule was complete. The blood supply on the surface was abundant, and the adhesion to the subclavian artery was tight. Complete removal was performed. . The specimens are elliptical, with multiple small lobes on the surface, and a necrotic zone in the center with multiple divisions around. Pathological diagnosis of ectopic thyroid follicular adenocarcinoma. There was no abnormality in thyroid B-ultrasound and ~(131) I examination after operation.